“Medication is a privilege, not a right.”

So said a nurse to an inmate a few years ago at the now-closed Toronto West Detention Centre.

There isn’t a provincial or federal jurisdiction in this country that would not tell us millions of dollars are spent every year on health-care needs in our jails and prisons. Tending to the physical and mental health of offenders is a top priority in the penal systems, and every option is explored to ensure timely resolutions as conditions dictate.

Why then is health-care the most consistent source of inmate complaints across the country?

Millions, no, tens of millions are spent annually to provide medical services in our institutions. Not long ago, Ralph Goodale, the federal minister responsible for Correctional Service of Canada, noted that $77-million was earmarked for mental health services in the federal system alone. Lots of our money is spent, but where are the benefits?

A point we can’t overlook is the difference between how we in the community access medical attention, and how prison inmates look for help. We have doctors and dentists to call, walk-in clinics, trauma centres, and 24-hour-a-day help lines. Generally, the more urgent the need, the faster the service. Even the pesky toothache can be dealt within 24 hours, or less.

Inmates, on the other hand, are put on lists for medical attention, fill out forms, and look for help by speaking to nurses during daily rounds. Unless in an emergency, meaning a critical and potentially fatal circumstance where outside intervention is necessary, inmates wait. And they wait. And they wait. It’s not unusual for that wait to continue for weeks and even months. To quote from Daz Dreisinger’s “Incarceration Nations”, “….knowing the circumstances of your oppression and being powerless to do anything about it—that’s torture.” Ergo, more complaints.

Yet, no prison/jail official will easily admit to failures in providing “timely resolutions.” All the same, examples proliferate. There’s the inmate in British Columbia whose lawyer took Correctional Service of Canada to court to force treatment and surgery for a cancer. Then, there’s the prisoner in Kingston Penitentiary a few years ago who waited seven months to see a dentist. Or, Mary Dwyer, head of health care in Ontario’s Toronto South Detention Centre, who testified at a legal action two years ago that she had never heard of any problems with the delivery of care at TSDC, and hadn’t read any newspaper reports to the contrary, but insisted that newspapers are not accurate in any case (a real Trumpist assertion, that).

As a rule, the incarcerated have higher rates of ill-health than the general population and therefore place a greater demand on available resources. Mental and emotional health issues affect a high percentage of inmates, and while medications are available and prescribed, counselling services are almost non-existent. Band-aids for symptoms are only the first step towards addressing mental illness and emotional stressors.

Until recently in Canada, the health-related needs of offenders were administered by the ministries responsible for the operation of our penal institutions, rather than our health ministries. “To suggest correctional authorities should provide health care is like saying plumbers should do your electrical work”, is how Ruth Elwood Martin, a family doctor and clinical professor at the University of British Columbia, put it.

This also means, among other things, that the cost of health care in our jails and prisons is a budget line, subject to what controls are necessary to keep costs in line. And, keeping costs in line affects management performance bonuses. So, health care for prisoners is dictated more by what resources are available rather than what resources are needed.

Times are beginning to change though. Alberta and Nova Scotia recently placed prison medical care under their health ministries. British Columbia will join them on October 1st of this year. Howard Sapers, the former federal prison ombudsman, and now reporting to Ontario on changes to its segregation policies, suggested Ontario do the same in the province’s institutions. Correctional Service of Canada has been encouraged for years to partner health care with the provincial systems.

The college of Family Physicians of Canada released a position statement in March asking Ottawa, the provinces and territories to act as B.C., Alberta and Nova Scotia have. In 2003, the World Health Organization called on nations to follow the lead of Norway, Britain and France, and deliver inmate health care through their respective ministries of health.

Jurisdictions that have made the switch report lower recidivism, improved file-sharing, greater participation in studies, more robust statistical monitoring and better treatment of TB, HIV, hepatitis C, and STDs.

Why should we care about this? No, why should we insist on change? A better response to the physical and mental health needs of the incarcerated translates into lower crime rates, and lower costs overall. Remember, these men and women in our institutions will one day return to the community.

This is a win-win issue!

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